Two-staged delayed open reduction and internal fixation of severe pilon fractures

Objective: To evaluate the use of a two-staged technique for the treatment of C3 pilon fractures. Design: Retrospective. Setting: Level 1 trauma center. Patients/Participants: Twenty-one consecutive patients with twenty-two C3 p ilon fractures. Patients with C1 or C2 fractures and patients with open gro wth plates were excluded. Intervention: All patients underwent immediate fibular fixation and placeme nt of a medial spanning external fixator. After, on average, twenty-four da ys, patients underwent removal of the external fixator and formal open redu ction and internal fixation of the pilon fractures. Main Outcome Measurements: At average follow-up of twenty-two months, all p atients were evaluated by using subjective, objective, and radiographic mea surements as described by Burwell and Charnley (J Bone Joint Surg 1965;47B: 634-659). Range of motion and postoperative complications were also recorde d. Results: Twenty-one of the twenty-two fractures healed within an average of 3.2 months. Average range of motion was 7 degrees of dorsiflexion, 33 degr ees of plantar flexion, 17 degrees of eversion, and 11 degrees of inversion . Subjective and objective measurements showed 77 percent good results, 14 percent fair results, and 9 percent poor results. Radiographic reduction sh owed 73 per cent anatomic and 27 percent fair reductions. There were no inf ections or soft tissue complications. The arthrodesis rate was 9 percent. Conclusions: A two-staged approach offers acceptable results for the treatm ent of severe pilon fractures. These results compare favorably with those o f primary open reduction and of internal fixation and external fixation tec hniques. The major advantages include limited soft tissue complications and improved articular reconstruction.